Social care for older people: Home truths

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Part of The sustainability of social care services

This report, published jointly with the Nuffield Trust, looks at the current state of social care services for older people in England, through a combination of national data and interviews with local authorities, NHS and private providers, Healthwatch and other groups. It considers the impact of cuts in local authority spending on social care providers and on older people, their families and carers. Alongside this work, we were commissioned by the Richmond Group of Charities to interview older people about their experiences of social care.

The picture that emerges is of social care providers under pressure, struggling to retain staff, maintain quality and stay in business; local authorities making unenviable choices about where to make reductions; a complex set of causes of delays in discharging older people from hospital; and the voluntary sector keeping services going even when funding was curtailed.

Key findings

  • Social care for older people is under massive pressure; increasing numbers of people are not receiving the help they need, which in turn puts a strain on carers.
  • Access to care depends increasingly on what people can afford – and where they live – rather than on what they need.
  • Under-investment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care The Care Act 2014 has created new demands and expectations but funding has not kept pace. Local authorities have little room to make further savings, and most will soon be unable to meet basic statutory duties.

Policy implications

Based on the evidence in the report, the authors recommend that policy-makers need to address three major challenges in shaping the development of social care over the next five years, focusing on how to:

  • achieve more with fewer resources – for example, through better commissioning and integrated care – recognising that these initiatives will not be enough to close the funding gap
  • establish a more explicit policy framework, which makes it clear that primary responsibility for funding care sits with individuals and families
  • reform the long-term funding of social care because reliance on additional private funding is unlikely to be sufficient or equitable.

Comments

Alisoun Milne

Position
Professor of Social Work and Social Gerontology,
Organisation
University of Kent
Comment date
15 September 2016
This report addresses a number of v important issues regarding the deplorable, fragmented and frankly scandalous state of care for older people in the UK. The govt are quite simply lying or not bothered or both. This is a huge political issue and is not being treated as one by our political leaders(?). We need honestly and transparency as the Kings Fund suggests, and reform of the care system including long term care funding which hits the most vulnerable when they are down. I feel ashamed and angry about how we treat older people in need. Thanks for your excellent work Kings Fund.

Elaine HIckling

Position
Business Improvement Manager,
Organisation
Hertfordshire County Council
Comment date
15 September 2016
I found this article very helpful and would like to be sent further updates.

Mark Coup

Position
Owner,
Organisation
Welcome Independent Living
Comment date
15 September 2016
The article is very interesting - if we applied the same policy approach to children there would be a national outcry. There is a real danger that social entrepreneurs like ourselves will walk away from this sector. The risks are too great (every day is a Daily Mail headline waiting to happen) and the rewards are too slim. Our Local Authority (Calderdale) and the CCG are innovative, creative and support local providers but year on year central government cuts are significantly impacting on your loved ones.

awaters

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
15 September 2016
Hi Elaine, glad to hear you found the report helpful. You can sign up for updates here: http://www.kingsfund.org.uk/about-us/get-latest-news-kings-fund. You can indicate your interest in social care by selecting the box under 'Your interest areas' to receive updates about our work in this area.

Adrian Adams

Position
Area Coordinator,
Organisation
Citizens Rights for Older People
Comment date
15 September 2016
This report mirrors the experiences of the volunteer advocates at Citizens Rights for Older People, a charity that provides advocacy, information and advice to older people.
We see on a daily basis older people struggling to survive in an increasingly complex and inadequate system that in spite of the rhetoric often leaves vulnerable people neglected and at risk.

Cherril Cliff

Position
Deputy Chair,
Organisation
Leeds Older People's Forum
Comment date
15 September 2016
I intend to read the full report. In a sense, it confirms what many of us already know; tens of thousands of older people not receiving the care they need and deserve and carers' at breaking point.

It surely is the responsibility of Government to support the most vulnerable in society and not to farm it out to private providers, who are often not employing people with the right skills because they are paying such low wages/terms of conditions. Also what happened to preventative care?

Then there are the older people stuck in hospital because there isn't a care package to get them discharged. This impacts hugely on older people themselves and the NHS; who are also teetering on a precipice.

Moira jenkins

Position
Law lecturer to social care students,
Organisation
Cork Institute of Technology and NUI Galway
Comment date
15 September 2016
Telling that older people, including those who self -identify as disabled, arent seen as having the same claim to personal budgets and advocacy. Enough of this. Ask what older people want and then respect and implement their decision.

David Stevens

Position
Chief Executive,
Organisation
Dementia Care
Comment date
16 September 2016
As a specialist dementia care provider, the report absolutely captures the issues that we face on a daily basis. Whilst the report focuses on older people generally, the issues are even more acutely felt by people with dementia and their families, who do not receive the support of the NHS despite being diagnosed with a long-term medical condition.

As a provider in the North East, one clear fault in the system identified in the report is the complete illogicality of basing a funding system for social care, not on need, but on house values and business rates. Social care is a people-business and we all have to pay at least the same National Minimum Wage, so how can we have such huge variations in the amounts that we are paid as care providers.

I would call on the government to fund social care at a national level (with local management to maintain quality), with national rates for care. This will start to move us away from the two tier system identified in the report.

Thank you Kings Fund for bringing the issues to the public attention. We all need to make sure that the politicians read it and do something about it before the system falls apart completely.

c james

Comment date
16 September 2016
I so agree, we should be ashamed and we should be fighting hard for both recognition and change before people die from neglect

Robert Arnott

Position
Community Worker,
Organisation
Ricoh Arena Community Space
Comment date
16 September 2016
There seems to be a state of denial by our politicians,despite all the
evidence by organisations like the Kings Fund that the provision of
healthcare in the UK is in need of urgent debate regarding its future.
I was born in the 1930s and I was privileged to grow up in a time when
people of vision created the NHS and Welfare State which have kept
the people of this country healthy for over 60 years,and I passionately
believe the NHS should remain an example of the best of public service
in the UK.The fact that a healthy population will live longer and in turn
place added demands on our services seems not to be taken seriously
by any political party,as we see by the present dire state of social care,
and unless this is addressed urgently,thing will only get worse.
The problems in our health service can be resolved,but only if the people
of the UK support the principle of a public service for all funded by the
taxpayer, and with politicians of all parties putting aside their idealogical
prejudice towards public services and bringing passion and vision to
the debate.

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